Dupuytren’s Contracture

Dupuytren’s contracture is a hand condition that causes one or more fingers to bend toward the palm, making them impossible to straighten completely. This gradual condition affects the tissue beneath the skin and most commonly impacts the ring and little fingers.

Table of contents

• What is Dupuytren’s Contracture?
• Symptoms and Progression
• Which Parts of the Hand Are Affected?
• Causes and Risk Factors
• How is it Diagnosed?
• Treatment Options
• What to Expect

What is Dupuytren’s Contracture?

Dupuytren’s contracture is a condition that affects the layer of tissue beneath the skin in the palm of the hand and fingers. In a normal hand, there is a fibrous tissue called fascia (a rubber-band like tissue under the skin that supports the hand and fingers). In people with Dupuytren’s contracture, this fascia gradually becomes thicker and tighter over time.^[1][2]

The condition is caused by a buildup of collagen, a protein with a fiber-like structure found in connective tissue. As the collagen thickens, it forms knots of tissue that eventually create thick cords under the skin. These cords can pull the fingers into a bent position toward the palm, sometimes severely. The affected fingers cannot straighten completely, even though the tendons themselves are not involved in the disease.^[3][7]

The growths that cause Dupuytren’s contracture are always benign, which means they are never a symptom or cause of cancer. While there is no cure for Dupuytren’s contracture, various treatments can relieve symptoms and slow how quickly the condition gets worse.^[1][2]

• Hand
• Palm
• Fingers
• Palmar fascia

Symptoms and Progression

Dupuytren’s contracture gets worse slowly, usually over months or years. Many people might not notice any symptoms at first because it can take a long time to develop. The condition is usually not painful, though some people may experience discomfort, especially in the early stages.^[5][2]

Symptoms typically develop in the following order:

Nodules are the first sign of Dupuytren’s contracture. Small bumps form under the skin on the palm, usually at the base of the fingers where they meet the palm. You might be able to feel or see them. The nodules may be tender initially but can become firmer and thicker over time. The skin around them may look dimpled or puckered, with deep indentations forming as the diseased tissue pulls on the overlying skin. Some people never get symptoms beyond nodules, and in some cases, nodules may even go away on their own.^[1][2][3]

Cords develop as the condition progresses. Over time, the nodules may thicken into long, hard cords of tissue on the fascia. These cords are often mistaken for tendons because they look and feel similar, but unlike tendons, they are not connected to muscles and do not move. The cords can pull on the fingers and make it feel like they are constantly being pulled inward toward the palm.^[2][6]

Contracture is the most advanced symptom. The tight cords pull one or more fingers toward the palm, reducing their mobility. This bending of the fingers makes it difficult or impossible to fully straighten them. When this happens, it can complicate everyday activities such as placing your hands in your pockets, putting on gloves, shaking hands, holding large objects, washing your hands, or performing tasks like buttoning clothes or typing.^[1][7][13]

Which Parts of the Hand Are Affected?

Dupuytren’s contracture most commonly affects the two fingers farthest from the thumb. The condition can affect any of your fingers, including the thumb, but it impacts them in a specific order of frequency:^[1][2][5]

• Ring finger (fourth finger) – most commonly affected
• Little finger (pinkie or fifth finger)
• Middle finger (third finger)
• Index finger (second finger)
• Thumb (first finger) – rarely affected

The condition often occurs in both hands at the same time. Each hand can be affected in a different pattern and at different times. It is common to have it in both hands simultaneously.^[5]

Dupuytren’s contracture most commonly affects the joint at the base of the finger called the MP joint (metacarpophalangeal joint) and the joint at the middle of the finger called the PIP joint (proximal interphalangeal joint).^[7]

The condition can only affect the hands and cannot develop in other parts of the body. However, some people with Dupuytren’s contracture are more likely to experience similar conditions affecting other areas, such as Ledderhose disease (affecting the feet) and Peyronie’s disease (affecting the genital area in men). Occasionally, thickening may occur on top of the knuckles, called a knuckle pad or Garrod’s pad.^[2][6]

Causes and Risk Factors

The exact cause of Dupuytren’s contracture is not completely known, but most evidence points toward genetics as having the most important role. The condition is a genetic disorder that often runs in families.^[2][3]

Some people are more likely to develop Dupuytren’s contracture than others. Risk factors include:^[1][2][6][7]

• Gender: Males are three to four times more likely to have Dupuytren’s contracture than females. Men also tend to experience more severe symptoms.
• Age: The condition is more common in people over 40 years old, and its severity increases with age. It is most prevalent in people over age 50.
• Ancestry: People of Northern European and Scandinavian descent are much more likely to develop Dupuytren’s contracture than people from other ethnic backgrounds. It is sometimes referred to as “Viking disease” and can be traced back centuries.
• Family history: People with a family member who has had the condition are more likely to develop it. The condition tends to run in families.
• Smoking: Smoking may increase the risk and worsen symptoms.
• Alcohol use: Drinking alcohol could worsen symptoms of the disease.

People with certain diseases or health conditions may be more likely to develop Dupuytren’s contracture, including:^[2][13]

• Diabetes
• Epilepsy and other seizure disorders
• Alcohol use disorder (formerly known as alcoholism)
• HIV and AIDS
• Vascular disease

There is no evidence that hand injuries or specific jobs lead to a higher risk of developing Dupuytren’s contracture. However, there may be a mild relationship to trauma in someone who is already at risk.^[6]

Dupuytren’s contracture is rare overall. Around 5% of people experience it, though people of European descent are much more likely to develop the condition than people from other ethnic backgrounds.^[2]

How is it Diagnosed?

Dupuytren’s contracture can usually be diagnosed based on your medical history and a physical examination, without the need for special tests. In most cases, the condition can be identified by the look and feel of the hands.^[9][6]

During the physical examination, your doctor will compare both hands with each other and check for puckering on the skin of the palms. They will also press on parts of the hands and fingers to check for hard knots or bands of tissue.^[9]

A simple test called the tabletop test is often used as a preliminary assessment. During this test, you try to lay your hand flat against a tabletop or other flat surface. If you cannot lay your palm flat on the table, it may indicate significant contracture, and treatment might be necessary.^[4][9][15]

Sometimes a history and examination is all that is needed to evaluate a mass in the palm. Other times, imaging such as an x-ray, ultrasound, or MRI may be indicated to rule out other conditions.^[6]

Treatment Options

Dupuytren’s contracture does not usually need any treatment in the early stages. If the disease progresses slowly, causes no pain, and has little impact on your ability to use your hands for everyday tasks, you might not need treatment. Instead, you can wait and monitor to see if the condition progresses.^[5][9]

If the condition becomes severe and you cannot straighten your fingers or use your hand normally, a doctor may refer you to a specialist for treatment. The right treatment for you depends on the severity of your condition, your overall health, and your personal preferences.^[5][13]

Non-Surgical Treatments

Non-surgical treatments are typically suitable for those in the early stages of Dupuytren’s contracture or for individuals who wish to avoid surgery:^[13]

Steroid injections may be given in the palm in the early stages of the disease. These injections can help soften and flatten hard lumps and may relieve local inflammation in cases of a painful nodule or cord. However, they are rarely used and may provide only temporary relief.^[9][18]

Collagenase injection therapy involves injecting an enzyme called collagenase into the affected tissue. This FDA-approved enzyme breaks down the collagen cords causing the contracture. After the injection, your specialist will manipulate the hand to improve finger movement. This treatment is done in an office setting without requiring general anesthesia.^[9][13][18]

Needle aponeurotomy (also called needle fasciotomy or needling) is a minimally invasive treatment. It uses a thin needle, inserted through numbed skin, to puncture and break up the thickened cords of tissue causing the contracture. This procedure provides immediate relief and allows most people to regain hand function without significant downtime. It can be done in an office setting with local anesthetic, and you can leave the hospital the same day. Recovery time is typically up to 2 weeks. However, the contracture is more likely to come back than with surgery, and it cannot be used in some places in the finger because it could damage a nerve or tendon.^{[5][9][13][18]}

Physical therapy after treatment can help improve hand strength and prevent the recurrence of contracture. A therapist can teach stretches and exercises to enhance the range of motion in your fingers. Activities such as applying heat to the palms before massage or exercise, gently massaging the thickened tissues, and performing stretching exercises may be helpful.^[13][18]

Surgical Treatments

Surgery may be the best course of action for those with advanced Dupuytren’s contracture or when non-surgical treatments are not effective:^[13][17]

Fasciectomy is a common surgical procedure where a cut is made along your palm and finger so the surgeon can remove the thickened tissue bands causing the contracture. This approach helps restore hand mobility. The procedure can be done under general anesthetic (you are asleep) or local anesthetic (your hand is numbed). You can leave the hospital the same day. Recovery time is typically 4 to 12 weeks. This has the lowest risk of the contracture coming back, but risks include bleeding, numbness, and infection.^[5][17]

Dermofasciectomy is similar to a fasciectomy, except an additional area of skin is removed. A skin graft from elsewhere in the body is used to replace the removed skin. The procedure can be done under general anesthetic (you are asleep) or local anesthetic (your hand is numbed). Two procedures are needed: one to straighten the fingers and then another procedure to add the skin graft. Contractures are less likely to come back than with a standard fasciectomy, but recovery times can be longer. Risks include bleeding, numbness, and infection.^[5][13]

The specialist will explain what the benefits and risks of each treatment option are. They will tell you what to expect afterwards, including advice on exercises to do. Your finger may not be completely straight after treatment and might not be as strong and flexible as it used to be. The contracture could also come back after a few years.^[5]

What to Expect

Dupuytren’s contracture might never affect your body in a way you notice. If you have mild symptoms, you may never even know you have it. Even if you do have symptoms, it usually takes a long time (months or years) for them to progress or get worse.^[2]

In many cases, Dupuytren’s contracture progresses very slowly over a period of years and may remain mild enough that no treatment is needed. However, in moderate or severe cases, the condition makes it difficult to straighten the involved fingers. When this happens, treatment may be needed to help reduce the contracture and improve motion in the affected fingers.^[3]

It is difficult to predict how the disease will progress. Some people have only small lumps or cords, while others will develop severely bent fingers. The disease tends to be more severe if it occurs at an earlier age. Men develop more severe symptoms when compared to women. If you have many relatives with the problem, you may be at higher risk for more severe disease.^[6]

Typically, as a contracture worsens, the involvement of the fascia becomes more severe, and treatment is less likely to result in a complete correction. Current treatments for Dupuytren’s disease all have limitations, including the risk of recurrence and complications. The contracture may come back even after treatment.^[3][4][11]

It is important not to wait for your contracture to get worse before looking into treatment. You do not have to wait for Dupuytren’s contracture to limit the use of your hand before seeking help. See a hand specialist as soon as you notice changes in your hand.^[4]